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NPI Code Detail

MEDICARE: JENNIFER M TINGLEY PRINCE LCSW

MEDICARE: JENNIFER M TINGLEY PRINCE LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerLC10171ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1098304OTHERMEANTHEM LEGACY NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275570400
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER M TINGLEY PRINCE LCSW
Provider Business Mailing Address
First Line : 29 FRANKLIN ST
Second Line :
City : BANGOR
State : ME
Zip : 04401-4909
Country : US
Telephone Number : 207-942-3816
Fax Number : 207-561-4725
Provider Business Practice Location Address
First Line : 62 ELM ST
Second Line :
City : PORTLAND
State : ME
Zip : 04101-3091
Country : US
Telephone Number : 207-553-7056
Fax Number : 207-773-2082
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2006
Last Update Date : 08/28/2009

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